Provider Demographics
NPI:1164546263
Name:IRENE MARIE ERCKERT, PH.D., P.C.
Entity Type:Organization
Organization Name:IRENE MARIE ERCKERT, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ERCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-817-2291
Mailing Address - Street 1:37 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3813
Mailing Address - Country:US
Mailing Address - Phone:215-817-2291
Mailing Address - Fax:609-406-9319
Practice Address - Street 1:444 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1945
Practice Address - Country:US
Practice Address - Phone:215-817-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3773103T00000X
PAPS007917-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA255349Medicare PIN